Characterizing the relationship between objective physical activity and momentary pain in cognitive behavioral interventions for chronic pain

项目总结 慢性疼痛(CP)是一种非常普遍的、代价高昂的、致残的生物、心理和社会疾病，越来越多地 应对认知行为干预，如接受和承诺疗法(ACT)和 认知行为疗法(CBT)这样的干预措施寻求最大化身体、社会和职业 通过处理与疼痛相关的想法、信念和行为来改变一个人管理疼痛的方式。 当前的CP文献受到主题间设计和自我报告措施的使用的限制，这些方法缺乏 生态有效性，可能会受到偏见的影响。功能的一个组成部分，体力活动，能够 使用加速度计以生态有效的方式进行客观测量。事实上，先前的研究已经结合了 使用生态瞬时评估(EMA)收集的加速度计和疼痛评级，以更好地反映 疼痛和体力活动之间的实时、真实的关系。这类研究表明，交叉- 从局部来看，是一种动态的人内疼痛-体力活动关系。我们假设这一动态 关系是可以通过认知行为干预而改变的，并试图在 患有CP的退伍军人，因为他们代表了CP研究的服务不足和合适的人群 这种情况的发生率高得不成比例。在目标1中，我们模拟了EMA评估的 7天基准期内的疼痛和客观体力活动，使用平行的潜在生长 曲线建模(LGCM)。我们假设，在基线上，疼痛和体力活动的增长轨迹 疼痛的增加将与体力活动的减少相关联。在目标2中，我们 使用多组分析来检查参与认知行为干预是否会改变关系 EMA疼痛的生长轨迹和客观的体力活动之间的关系。我们假设，在- 干预后，疼痛的生长轨迹与体力活动之间的关系将显著 与基线相比发生了变化。在我们的探索性目标中，我们进行后续访谈，以定性地探索 治疗如何影响个人与他们的疼痛的关系。因此，拟议的研究将审查 疼痛与体力活动的关系及其认知行为后的变化 干预。结构方程模型(即LGCM)和定性方法的使用将结合起来 更完整地描述CP和治疗的经历。因此，这项研究的结果将 解决在理解和概念化CP中的功能方面存在的局限性，提供信息 浅谈如何改善脑瘫患者的功能，促进认知功能的改善和完善 治疗慢性阻塞性肺病的行为干预。重要的是，这个项目将推进申请者的长期 成为一名独立的临床研究人员的目标，致力于应用先进技术和 为改善CP的治疗提供统计工具。

PROJECT SUMMARY Chronic pain (CP), a highly prevalent, costly, and disabling biopsychosocial condition, is being increasingly addressed with cognitive behavioral interventions such as Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT). Such interventions seek to maximize physical, social, and occupational functioning by changing how one manages pain via addressing pain-related thoughts, beliefs, and behaviors. The current CP literature is limited by the use of between-subject designs and self-report measures that lack ecological validity and may be subject to bias. One component of function, physical activity, is able to be objectively measured in an ecologically valid way using accelerometry. In fact, prior research has combined accelerometry and pain ratings collected using ecological momentary assessment (EMA) to better reflect the real-time, real-world relationship between pain and physical activity. Such research has indicated cross- sectionally a dynamic within-person pain-physical activity relationship. We hypothesize that this dynamic relationship is alterable by cognitive behavioral intervention and seek to examine this research question in Veterans with CP, as they represent an underserved and apt population for CP research given disproportionately high rates of this condition. In Aim 1, we model the relationship between EMA-assessed pain and objective physical activity over a 7-day baseline period, within-person, using parallel latent growth curve modelling (LGCM). We hypothesize that at baseline, the growth trajectories of pain and physical activity will be related such that increases in pain will be associated with decreases in physical activity. In Aim 2, we use multigroup analysis to examine if participation in a cognitive behavioral intervention alters the relationship between the growth trajectories of EMA pain and objective physical activity. We hypothesize that, post- intervention, the relationship between the growth trajectories of pain and physical activity will be significantly altered compared to baseline. In our Exploratory Aim, we conduct follow-up interviews to qualitatively explore how treatment impacts how individuals relate to their pain. Therefore, the proposed research will examine the relationship between pain and physical activity and if and how it changes after cognitive behavioral intervention. The use of structural equation modelling (i.e., LGCM) and qualitative methods will be combined to portray a more complete picture of the experience of CP and treatment. Thus, findings from this study will address existing limitations in the understanding and conceptualization of function in CP, provide information on how to improve function in individuals with CP, and promote the improvement and refinement of cognitive behavioral interventions for the treatment of CP. Importantly, this project will advance the applicant’s long-term goal of becoming an independent clinical researcher committed to applying advanced technological and statistical tools to the improvement of treatments for CP.